PROJECT SUMMARY/ABSTRACT As a predominantly rural state, Kentucky leads the nation in many pediatric and adult chronic and environmentally-related diseases and ?ranks nationally? in low educational achievement. These adverse factors combine to make Kentuckians especially unhealthy residents with a high prevalence of obesity, diabetes, smoking, alcohol use, heart disease, stroke, lung cancer, etc. Many of these diseases are environmentally related to poor nutrition, obesity, smoking, drug abuse and work-place exposures. Kentucky also leads the nation in the percentage of pediatric populations with special health care needs. Prior work has shown that most adult diseases begin in childhood and some begin during intrauterine exposure, making childhood the ideal time for intervention with the goal of improving health outcomes into adulthood. Improving healthcare outcomes and wellness in children is contingent on expanding high quality clinical research to include more diverse populations. Pediatricians at the University of Louisville (UofL) with our Healthcare Partners serve a highly diverse patient population that includes the rural and urban poor, a unique Appalachian community, refugees and numerous ethnic minorities. In order to better serve this population, we propose to build upon our current programs, expand our bidirectional community engagement efforts, collaborate with other institutions on pediatric clinical trials through the IDeA Pediatric Trials Network, and collaborate with ECHO and CHEAR sites to advance healthcare for children. The Kentucky-Pediatric IDeA Research Center (K-PIRC), as part of the IDeA States Pediatric Clinical Trial Network, will make it possible for 1) underserved rural and urban infants, children and adolescents to participate in clinical research; 2) junior investigators to be trained in clinical research and community engagement, improve the health of both children and adults in Kentucky through this research, and develop their academic career; and 3) create a regional network of partners to sustain this clinical research initiative. The four primary focus areas of research are 1) upper and lower airway disease; 2) obesity; 3) pre-, peri- and postnatal outcomes; and 4) neurodevelopmental outcomes. These primary focus areas have a high prevalence in Kentucky therefore K-PIRC will enable strengthening current collaborations and accelerate the development of new networks within the state through bidirectional community engagement and feedback to support pediatric clinical research. Ultimately through these efforts the health outcomes of Kentucky children and adults will improve and a sustainable pediatric clinical research workforce locally and nationally will be established.